“It forces the director of wellness to
ensure they’ve consulted all the pharmacists and outside providers and done all
the interventions” from week to week,
Arden says.

Like many companies, Brookdale recognizes and honors communities that
excel during site visits, and communities compete for year-end awards for top
quality in each division. Every staffer in
the community who scores highest in
the company’s quality index receives a
monetary bonus and an award certificate.
Communities that fared poorly during
internal reviews are put on individual improvement plans.

That said, experts also advise resisting
the urge to focus on summary scores and
outcomes, rather than on improving the
way your company reaches positive outcomes. Results of site visits to individual
communities should be made known all
the way up to the corporate suite, but the
goal should be to identify and support what
communities need, and learn from their
success stories, rather than accountability
alone. To take its site survey results a step
further, Brookdale examines high-scoring
communities and uses their strengths as
models to continually raise the bar of what
is considered “quality.” “Look at what it is
about them that’s a recipe for success,”
says Maguire.

Colon agrees. “It’s not just about where
you fall on the scale. If people are solely
concerned about that, we’re missing the
point.”

enhancing the social Model

As the acuity level of assisted living
residents creeps higher and care needs
become more complex, customers’ expectations of quality tend to deepen accordingly. “They want to see that their loved one is
well cared for,” says Maguire. “Then, when
their care needs become more complex,
they look to us as the experts.” Consumers
want to know what providers have done to
help reduce the risk of a fall, or of elopement, or of whatever problem that their
particular loved one is prone to have.

But while assisted living providers increasingly must deal with such care challenges as pressure sores and dementia,

Results of sitevisits to individualcommunities shouldbe made known allthe way up to thecorporate suite, butthe goal should be toidentify and supportwhat communitiesneed, and learnfrom their successstories, rather thanaccountability alone.

Maguire cautions against resorting to a
skilled nursing approach in the pursuit
of quality. It’s important to remain clear
about residents’ overall needs, not just
their medical requirements. “While there
are certainly good outcomes of that model, it would be a shame to just use that
model and not look for a newer model,”
she says. “So while you have to be vigilant
[about quality care], you also have to look
at customer satisfaction and that nebulous
quality of life.”

Amparo agrees. “The only way to be
able to meet residents’ needs is to think
differently than 10 years ago,” he asserts.
“It is still a social model, but you need to
add more assistance in place to meet higher demands from our residents.”

Naturally, companies need to continually reassess their quality review process,
to make it both relevant to the times and
true to the ideals of assisted living. In
order to keep the “resident-centered” approach to aging that is the hallmark of
assisted living, Brookdale has identified
six areas comprising “optimum life” for
its residents. These include social, spiritual, physical, emotional, purposeful, and
intellectual domains. Any site reviews and
improvements to the site review process
must address these areas. “The idea that
quality can be measured within these
realms, as well, is what we need to be looking for,” says Maguire. For example, the
site visit reviewers look for tangible ways
that these six domains have been put into
action, Maguire says, and associates are
asked to describe optimum life. “How are
your residents engaged? Are you offering
the right programs? We have to broaden

to look at these less traditional measures,
too,” she adds.

Of course, the most important feedback
that sometimes yields the best measure of
quality is less a formal metric and more
akin to the “dinner rule.” It’s that elusive
feeling of having observed quality-in-ac-tion during a site visit that comes from
what Maguire calls the “climate check,”
and Arden calls having “surveyor’s eyes.”

“Go into a community and if your
residents are smiling, very friendly, and
the same with your staff, very accommodating, you will sense it,” says Amparo.
“Do not rely on just one indicator. Try for
balance.”

“There are specific questions that you
can ask to ensure the caregiver is doing
certain things, but you can get so much
more by observing the interaction,” Colon
says. ❏

Whitney Redding is a contributing writer
to Assisted Living Executive. Reach her at
wredding@alfa.org.